Tinnitus retraining therapy

Tinnitus retraining therapy (TRT) is a form of habituation therapy designed to help people who suffer from tinnitus, a ringing, buzzing, hissing, or other sound in the ears when no external sound is present. Two key components of TRT directly follow from the neurophysiological model of tinnitus. One of these principles includes directive counseling aimed at reclassification of tinnitus to a category of neutral signals, while the other includes sound therapy which is aimed at weakening tinnitus related neuronal activity.

The goal of TRT is management of tinnitus; there is no evidence that TRT can attenuate or eliminate tinnitus. The efficacy of TRT in reducing the distress of tinnitus has not been established.

An alternative to TRT is tinnitus masking, the use of noise, music or other environmental sounds to obscure or mask the tinnitus. Hearing aids can provide a partial masking effect for the condition. Results from a review of tinnitus retraining therapy trials indicate that it may be a more effective treatment than tinnitus masking.

Not everyone who experiences tinnitus is significantly bothered by it. However, some of the problems caused by tinnitus include annoyance, anxiety, panic, and loss of sleep and/or concentration. The distress of tinnitus is strongly associated with various psychological factors; loudness, duration and other characteristics of the tinnitus are secondary.

TRT may offer real although moderate improvement in tinnitus suffering for adults with moderate-to-severe tinnitus, in the absence of hyperacusis, significant hearing loss and/or depression. Not everyone is a good candidate for TRT. Factors associated with suitability for TRT and predisposing for favorable outcome are: lower loudness of tinnitus, higher pitch of tinnitus, shorter duration of tinnitus since onset, recognition of tinnitus attenuation by sound generator, lower hearing thresholds (i.e. better hearing), high Tinnitus Handicap Inventory (THI) score, and positive attitude toward therapy.

Despite the fact that there haven't been any recent studies which concluded in its optimal treatment, tinnitus retraining therapy has been applied to treating hyperacusis, misophonia, and phonophobia.

There is no evidence that TRT or any other treatment can eliminate or decrease tinnitus. Tinnitus is a symptom, not a disease. As such, the optimal treatment strategy should be directed toward eliminating the disease, rather than simply alleviating the symptom. More than half of people with tinnitus have a comorbid psychological injury or illness (e.g., post-traumatic stress disorder, depression, anxiety, obsessive compulsive disorder, stress, dysfunction of the temporomandibular joint, etc.) that can exacerbate the tinnitus.

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